Quality of life from cytoreductive surgery in advanced ovarian cancer: Investigating the association between disease burden and surgical complexity in the international, prospective, SOCQER‐2 cohort study

Sundar, Sudha; Cummins, Carole; Kumar, Satyam; Long, Joanna; Arora, Vivek; Balega, Janos; Broadhead, Tim; Duncan, Timothy J.; Edmondson, Richard J.; Fotopoulou, Christina; Glasspool, Rosalind; Kolomainen, D; Leeson, Simon; Manchanda, Ranjit; McNally, Orla; Morrison, Jo; Mukhopadhyay, Asima; Paul, James; Tidy, John; Wood, N

doi:10.1111/1471-0528.17041

Cited by 22 publications

(22 citation statements)

References 46 publications

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“…From the magnitude of effect sizes in comparisons of 0 cm versus larger amounts of RD (where there were sufficient evidence available for a give RD threshold), it seems that if RD cannot be limited to an optimal level then the surgeon could potentially prioritize their focus on morbidity and quality of life (QoL). The results of the SOCQER-2 102 study commissioned by NICE, assessed QoL in women undergoing standard or extensive surgery after primary surgery in advanced EOC. This study found no important differences in global QoL scores measured across 6 weeks, 6 months, and 12 months postsurgery in varying complexities of surgery.…”

Section: Discussionmentioning

confidence: 99%

Residual Disease Threshold After Primary Surgical Treatment for Advanced Epithelial Ovarian Cancer, Part 1: A Systematic Review and Network Meta-Analysis

Bryant

Johnson

Grayling

et al. 2022

American Journal of Therapeutics

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Background: We present a systematic review and network meta-analysis (NMA) that is the precursor underpinning the Bayesian analyses that adjust for publication bias, presented in the same edition in AJT. The review assesses optimal cytoreduction for women undergoing primary advanced epithelial ovarian cancer (EOC) surgery.Areas of Uncertainty: To assess the impact of residual disease (RD) after primary debulking surgery in women with advanced EOC. This review explores the impact of leaving varying levels of primary debulking surgery.Data Sources: We conducted a systematic review and random-effects NMA for overall survival (OS) to incorporate direct and indirect estimates of RD thresholds, including concurrent comparative, retrospective studies of $100 adult women (18+ years) with surgically staged advanced EOC (FIGO stage III/IV) who had confirmed histological diagnoses of ovarian cancer. Pairwise meta-analyses of all directly compared RD thresholds was previously performed before conducting this NMA, and the statistical heterogeneity of studies within each comparison was evaluated using recommended methods.Therapeutic Advances: Twenty-five studies (n 5 20,927) were included. Analyses demonstrated the prognostic importance of complete cytoreduction to no macroscopic residual disease (NMRD), with a hazard ratio for OS of 2.0 (95% confidence interval, 1.8-2.2) for ,1 cm RD threshold versus NMRD. NMRD was associated with prolonged survival across all RD thresholds. Leaving NMRD was predicted to provide longest survival (probability of being best 5 99%). The results were robust to sensitivity analysis including only those studies that adjusted for extent of disease at primary surgery (hazard ratio 2.3, 95% confidence interval, 1.9-2.6). The overall certainty of evidence was moderate and statistical adjustment of effect estimates in included studies minimized bias. Conclusions:The results confirm a strong association between complete cytoreduction to NMRD and improved OS. The NMA approach forms part of the methods guidance underpinning policy making in many jurisdictions. Our analyses present an extension to the previous work in this area.

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Section: Discussionmentioning

confidence: 99%

Residual Disease Threshold After Primary Surgical Treatment for Advanced Epithelial Ovarian Cancer, Part 1: A Systematic Review and Network Meta-Analysis

Bryant

Johnson

Grayling

et al. 2022

American Journal of Therapeutics

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“…We found that in cohorts balanced for age and morphology, centres with greater utilization of URS increased the proportion of patients treated surgically compared to centres that mainly practiced low complexity surgery. However, centres practicing mainly intermediate SCS were most likely to deliver both surgery and chemotherapy; this may reflect greater use of surgery for palliation, e.g., bowel obstruction in high SCS centres but may also reflect challenges in delivery of chemotherapy after ultra-radical surgery, although this was not observed in the UK-based SOCQER2 study [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Consecutive participants were identified prior to surgical treatment and recruited between September 2015 and September 2016 and followed up to 24 months. Results from the study and description of variation in surgical practice across centres have been previously reported [ 9 ]. This paper describes population level outcomes for Stage3/4 and unstaged ovarian cancer patients managed at the 11 participating centres in England.…”

Section: Methodsmentioning

confidence: 99%

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Investigating the Impact of Ultra-Radical Surgery on Survival in Advanced Ovarian Cancer Using Population-Based Data in a Multicentre UK Study

Cummins

Kumar

Long

et al. 2022

Cancers

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We investigated URS and impact on survival in whole patient cohorts with AOC treated within gynaecological cancer centres that participated in the previously presented SOCQER 2 study. National cancer registry datasets were used to identify FIGO Stage 3,4 and unknown stage patients from 11 cancer centres that had previously participated in the SOCQER2 study. Patient outcomes’ association with surgical ethos were evaluated using logistic regression and Cox proportional hazards. Centres were classified into three groups based on their surgical complexity scores (SCS); those practicing mainly low complexity, (5/11 centres with >70% low SCS procedures, 759 patients), mainly intermediate (3/11, 35–50% low SCS, 356 patients), or mainly high complexity surgery (3/11, >35% high SCS, 356 patients). Surgery rates were 43.2% vs. 58.4% vs. 60.9%. across mainly low, intermediate and high SCS centres, respectively, p < 0.001. Combined surgery and chemotherapy rates were 39.2% vs. 51.8% vs. 38.3% p < 0.000 across mainly low, intermediate and high complexity groups, respectively. Median survival was 23.1 (95% CI 19.0 to 27.2) vs. 22.0 (95% CI 17.6 to 26.3) vs. 17.9 months (95% CI 15.7 to 20.1), p = 0.043 in mainly high SCS, intermediate, and low SCS centres, respectively. In an age and deprivation adjusted model, compared to patients in the high SCS centres, patients in the low SCS group had an HR of 1.21 (95% CI 1.03 to 1.40) for death. Mainly high/intermediate SCS centres have significantly higher surgery rates and better survival at a population level. Centres that practice mainly low complexity surgery should change practice. This study provides support for the utilization of URS for patients with advanced OC.

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“…Surgery frequently involves liver mobilization, excision of diaphragmatic peritoneum, bowel resection, and splenectomy. Mortality ranges from 1% to 3% with anastomotic leakage being a key contributor 1…”

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confidence: 99%

How do we deliver safe bowel resection in ovarian cancer cytoreductive surgery?

Wood

Dobbs

Tierney

et al. 2022

Int J Gynecol Cancer

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Quality of life from cytoreductive surgery in advanced ovarian cancer: Investigating the association between disease burden and surgical complexity in the international, prospective, SOCQER‐2 cohort study

Abstract: Objective: To investigate quality of life (QoL) and association with surgical complexity and disease burden after surgical resection for advanced ovarian cancer in centres with variation in surgical approach.

Cited by 22 publications

References 46 publications

Residual Disease Threshold After Primary Surgical Treatment for Advanced Epithelial Ovarian Cancer, Part 1: A Systematic Review and Network Meta-Analysis

Residual Disease Threshold After Primary Surgical Treatment for Advanced Epithelial Ovarian Cancer, Part 1: A Systematic Review and Network Meta-Analysis

Investigating the Impact of Ultra-Radical Surgery on Survival in Advanced Ovarian Cancer Using Population-Based Data in a Multicentre UK Study

How do we deliver safe bowel resection in ovarian cancer cytoreductive surgery?

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